What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular diseases mortality (n=5564). Intervention: Time period (2016-2018) vs. Time period (2000-2002). Primary outcome: Age-standardized mortality rates (ASMR) for cardiovascular diseases per 100,000 inhabitants (-31% (percent change)).

April 17, 2025Open Access

Cardiovascular diseases mortality in Brazilian municipalities: estimates from the Global Burden of Disease study, 2000–2018

Key Result

Age-standardized mortality rates for cardiovascular diseases in Brazil decreased by 31% from 2000 to 2018, with smaller reductions observed in smaller municipalities and more vulnerable regions.

Study Design

Type

Observational (n=5,564)

Structured PICO

Population

5564 Brazilian municipalities from 5 regions, stratified by population size (<30,000, 30,000-300,000, and >300,000 inhabitants)

Outcome

Age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) and % changes from 2000-2002 to 2016-2018hard clinical

The reduction in cardiovascular disease mortality in Brazil between 2000 and 2018 was uneven, with smaller and less developed municipalities experiencing significantly less improvement compared to larger, more developed ones.

Main Result

Effect estimate: -31% (percent change)

Absolute Event Rate: 178% vs 257%

Limitations

Modelling of GBD estimates is dependent on data completeness and quality, which may vary according to federal unit and smaller municipalities
The Brazilian Deprivation Index is a local measure and not an individual metric, and may not reflect the circumstances of all citizens within an area
Other metrics related to infrastructure and access to healthcare were not considered
Sociocultural, demographic, economic and ethnic heterogeneity of the cities may not be adequately captured by the analytical models
Uses GBD estimates from the 2019 version, which includes SIM mortality data only until 2018

Abstract

Background: Age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) have decreased in Brazil in the last decades due to better control of risk factors and access to healthcare. However, how this reduction is distributed across the country's municipalities is unknown. We aimed to evaluate changes in CVD mortality rates across Brazilian municipalities from 2000 to 2018 using estimates from the Global Burden of Disease (GBD) study. Methods: In this ecological study, ASMR for CVD were estimated using GBD methodology for 5564 Brazilian municipalities from 5 regions in the triennials: 2000-2002, 2009-2011, 2016-2018. A visuospatial analysis was applied to create clusters in ASMR with Moran Local analysis. Municipalities were stratified by population size in 300,000 inhabitants per region. The % changes in ASMR from 2000-2002 to 2016-2018 were calculated. Findings: In 2000-2002, ASMR for CVD were higher in more developed regions and in larger municipalities of all regions, except for the South. In 2016-2018, CVD ASMR increased in the least developed Northern regions. The % reduction in CVD ASMR was lower in small vs large municipalities within all 5 regions, varying from -3% in small Northern municipalities to -43% in large Southern municipalities. Interpretation: The reduction in CVD mortality in Brazil was lower in municipalities from the most vulnerable regions and smaller populations. Public policies tailored to these smaller municipalities, particularly on the least developed regions, must be considered a priority. Funding: Brazilian Ministry of Health grant 148/2018 and Pan American Health Organization Letter of Agreement SCON2021-00288.

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